Vision, Learning and AD(H)D

Good vision skills can help provide a solid foundation for learning. If a child does not have a good visual foundation, their system is not efficient enough to handle large work loads because it puts too much stress on such a weak system. A poor visual system can lead to poor performance in school.

There are a multitude of reasons why a child may be having trouble in school, and vision is just one of them. Often, it is a combination of problems and one remedy will not solve them all. This is why a multi-disciplinary approach is best, so that no one factor will be left out. However, any problem that CAN be corrected makes it that much easier for a child to be successful. Vision is such a problem than can be taken out of the puzzle. It is treatable and the earlier vision problems are detected and treated, the better. It is for this reason that vision should be checked promptly if your child is falling behind in school and why everyone, especially children, should have their eyes routinely checked.

Following is a list of signs and symptoms that could mean your child has a vision problem:

Signs & Symptoms of Vision Problems

d Failed school vision screening

d Failed eyechart (acuity) test

d Recommendation by:

- Teacher
- Physician
- Psychologist
- Optometrist
- Other Professional

d Behind in school

d Not working up to potential

d Hyperactivity

d Frustrates easily

d Poor or short attention span

d Difficulty reading

- Reads below grade level
- Lose place frequently
- Holds material too close
- Poor comprehension
- Skips lines
- Repeats lines
- Adds extra words

d Has an eye that turns in or out

d Poor eye movements

d Poor hand-eye coordination

d Physically awkward

d Scores low on standardized tests

d When reading/writing:

- Covers an eye
- Turns head to side
- Complains of blur or double vision
- Eyes itch or burn
- Eyes hurt
- Reverses letters/words (>3rd grade
- Headaches

d Trouble in spelling or language arts

d Trouble copying from chalkboard

d Trouble copying from books

d Perception problems

d Failed depth perception/fusion tests

d Poor motivation

d Difficulty writing

- Letter formation
- Cannot stay on line
- Sloppy
- Crowds letters
- Eyes too close to paper
- Grips pencil incorrectly
- Rich vocabulary, but not on paper

d Excessive effort needed to achieve

d Not working up to potential

d Diagnosed with a learning disability

d Trouble in sports

d Does not work well on their own

For another list of problems that can be seen in a classroom, check out the educator's checklist by clicking here.

Do you suspect your child has a vision problem?

If you suspect your child has a vision problem, we suggest finding a doctor that specializes in children and making an appointment for an optometric consultation. If do not know of any, please click here to find a doctor in your area.

dIt is estimated that 3%-7% of school age children have ADHD, or about 4 million American children. Boys outnumber girls 3 to 1 and are more often diagnosed with ADHD.

Once thought that symptoms fade with the onset of adulthood, it is now estimated that 1/3 to 2/3 of all ADHD children become ADHD adults.

The only problem is 15 out of the 18 symptoms used to diagnose AD(H)D in the (Diagnostic and Statistic Manual, Version IV) are also symptoms of vision related learning problems.

Many children truly do suffer from ADD and ADHD, but certain visual and learning problems mirror the same symptoms and are misdiagnosed.

Children with vision problems, even those such as hyperopia (farsightedness), accommodative (focusing), or binocular dysfunctions (how their eyes work together), may exhibit the same signs as ADD/ADHD in the classroom.

Children with vision related learning problems often have 20/20 eyesight, but have difficulties with other key visual skills. Their visual systems cannot tolerate the demands within the classroom for very long, so avoidance behaviors are common.

General habits that may be observed in children with vision problems, but can also be AD(H)D symptoms include:

  • Careless mistakes in homework and class work
  • Poor ability to sustain attention and stay on task
  • Poor listening skills
  • Difficulty following directions
  • Loses and misplaces things often
  • Talks excessively and interrupts others
  • Fidgety
  • Difficult time organizing, prioritizing work and activities
  • Shifts from one activity to another
  • Difficulty playing quietly

dPsychostimulant Medications and their Visual Side Effects

65%  number of children diagnosed with AD(H)D are treated with psychostimulant medications. In 2002, it was estimated that more than 2.7 million American children aged 5 to 18 were taking Ritalin alone.

Yet, these medications have been found to improve easier manageability of children and increased time on tasks, but it has not been proven that these medications actually affect academic achievement. One double blind study shows no cognitive, academic or behavior improvement over time between children diagnosed with ADHD that have taken medication compared to those who have not.

Paradoxically, these drugs can also cause visual side effects that can actually make it more difficult for a child with AD(H)D to concentrate on learning related tasks. Ritalin, Concerta, Metadate, Daytrana (methylphenidate), Focalin (dexmethylphenidate), Dextrostat, Dexedrine (dextroamphetamine), Adderal (amphetamine), and Vyvanse (Lisdexamfetamine) may include decreased focusing power, dilated pupils (also related to focusing) and blurry vision. Cylert (pemoline) can cause double vision, eye turns and nystagmus ("jumpy" eyes).

If a child has already been experiencing some of these visual problems, these medications may actually enhance their problem and make it more difficult to keep their attentional focus.

Nonstimulant Medications also have Visual Side Effects

Even the nonstimulant medications are not without their visual issues. Strattera (atomoxetine) and Wellbutrin (bupropion) both can cause "visual changes" and blurry vision.

AD(H)D Should be a Diagnosis of Exclusion.

Careful diagnosis of AD(H)D is important so as not to potentially inappropriately medicate a child.

Rule out other causes of the same signs and symptoms of AD(H)D such as the following:

  • Vision Problems
  • Hearing Problems
  • Allergies, including food
  • Nutritional Deficiencies
  • Depression or other Behavioral Problems
  • Other Health Problems

It is recommended that all children suspected of having AD(H)D have a comprehensive vision analysis by a Behavioral Optometrist to avoid the possibility of misdiagnosis and unnecessarily medicating children.

Vision, however, can be only ONE piece of a complex puzzle.  It is even possible to have both a vision related learning problem and AD(H)D.  A  multidisciplinary approach is important to fully assessing AD(H)D.  

If you still suspect ADD/ADHD, who makes the diagnosis?

Any physician is actually able to diagnose these disorders. However, many general practitioners do not take the time to make sure their patient fits all the criteria for diagnosis, before they determine it is the only cause of the symptoms. Often their first treatment is to prescribe medication.

Psychiatrists are specialty medical doctors. Child and adolescent psychiatric training requires 4 years of medical school, at least 3 years of approved residency training in medicine, neurology, and general psychiatry with adults, and 2 years of training in psychiatric work with children, adolescents, and their families in an accredited residency in child and adolescent psychiatry. They are trained to look at biological and physiological problems, but also psychological and social factors in working with patients.

Psychologists obtain their doctorate in clinical psychology (though their our masters programs available in counseling) and pass board tests in order to practice. They also look at psychological and social factors when working with patients, as well as the physiological and biological factors, since mind and body are closely linked. At this time are not able to prescribe medication themselves, but do take more time to observe the child to make a proper diagnosis. If medication is deemed necessary, they will refer to the appropriate professional.

Other professionals, such as teachers, school counselors, optometrists, etc., can recognize the signs and symptoms of ADD/ADHD and may refer you to one of the above professionals for appropriate testing to rule out these disorders.

Unfortunately, many children are being diagnosed hastily by primary care physicians, pediatricians, etc. based on parent or teacher recommendations. This often leads to medication prescriptions to handle the problem. It is our opinion that a person that specializes in behavioral conditions, such as a psychiatrist or psychologist, will be able to test and observe a child more thoroughly to diagnose individuals with ADD/ADHD and decide if medication is absolutely necessary. They are also trained to rule out other possible behavioral issues.

This is not meant to undermine the family doctors and pediatricians. It is meant to illustrate that there are specialists specifically trained in behavioral problems. If you were having a baby, would you want your family physician taking care of you, or would you want to go to an obstetrician that is specially trained to deliver babies? Your family physician may know how to deliver a baby, but the obstetrician does it all the time and will be more trained to handle problems along the way. The same goes for a diagnosis of a behavioral problem that will be there FOR THE REST OF THE CHILD'S LIFE. Isn't it worth the extra effort to be thorough?

Take Home Message

Investigate and rule out all areas that may be affecting attention, "focus" and learning before medicating.

Ritalin Cartoon





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